Surgical Treatment of Congenital Radioulnar Synostosis in Children: Systematic Review

Abstract

Background. Congenital radioulnar synostosis (CRUS) may have a negative impact on the function of the upper limb and cause disability. The main aim of the surgical treatment is to correct the forearm position for diminishing functional limitations. The study aimed to analyze the variety of surgical methods for correction of the pronation forearm deformity in children with congenital radioulnar synostosis based on the literature data. Methods. We have searched publications in eLIBRARY, PubMed (MEDLINE), Ovid, ScienceDirect, Google Scholar databases. The analysis has included the age at surgery, indications for surgery, the target functional forearm position, the time of consolidation of the forearm bones, the frequency of neurovascular complications. Results. Most authors considered subjective complaints as the main indication for surgical treatment, while some researchers recommended taking into account the forearm hyperpronation position. The median age of the surgical treatment was 5.17 years (3.25-9.46). The medians of the recommended forearm positions for unilateral CRUS were 0-10 of pronation for the dominant, and 0-12.5 of supination for the non-dominant limb; with bilateral cases 0-17.5 pronation for the dominant and 0-12 supination for the non-dominant limb. Median of the osteotomy consolidation time varied from 6 to 8 weeks. The maximal time of forearm bone consolidation was significantly higher (p = 0.024) in the group with osteotomies through the synostosis site. Though the target forearm position was achieved in all cases, the number of complications in the proximal osteotomy group was statistically significantly different (p0.01). The chances of neurovascular complications were 20.5 times higher in the group of patients who underwent osteotomy through the synostosis (95% CI: 2.7-155.6). Conclusions. The problem of surgical treatment of children with CRUS in the world medical practice remains relevant despite the wide range of proposed methods. The development of an algorithm regarding the need for surgical treatment and its methodology requires further high-quality research.